Various forms of therapeutic superficial tissue manipulation have been practiced for thousands of years across cultures. Chinese use of massage dates to 1600 BC, and Hippocrates made reference to the importance of physicians being experienced with "rubbing" as early as 400 BC. There are references to massage in ancient records of the Chinese, Japanese, Arabic, Egyptian, Indian, Greek, and Roman nations. References to massage are also found in the Bible and the Vedas. Terms for massage include the French word masser, the Greek word for "knead," a Hindu word for "press," and an Aramaic word that means "to press softly." The technique that is currently called Swedish massage was developed in the 19th Century by Per Henrik Ling (1776-1839) as a combined form of massage and gymnastic exercises.

Many different therapeutic techniques can be classified as massage therapy. Most involve the application of fixed or moving pressure or manipulation of the muscles/connective tissues of clients. Practitioners may use their hands or other areas such as forearms, elbows, or feet. Lubricants may be added to aid the smoothness of massage strokes.

Techniques used in Swedish massage include (1) superficial stroking in a direction away from the heart or deep stroking towards the heart; (2) kneading in a circular pattern using fingers and thumbs; (3) deep muscle stimulation; (4) rhythmic movements such as slapping or tapping; and (5) vibration.

Sports massage is similar to Swedish massage but is adapted specifically for athletes. Classical massage aims to provide calmness, relaxation, encourage self-healing, and revitalization. Many other variations and styles of massage or touch exist, often developed in specific geographic regions.

Scientific research of massage is limited, and existing studies use a variety of techniques and trial designs. Firm evidence-based conclusions about the effectiveness of massage cannot be drawn at this time for any health condition.

Numerous theories exist on how massage therapy may be beneficial, although there is limited research on the mechanism of action. It has been suggested that massage may have local effects on muscles and soft tissues and may reduce inflammation, stimulate oxygenation of tissues, soften or stretch scar tissue, break up adhesions, reduce buildup of lactic acid in muscles, induce muscle fiber relaxation, and stimulate healing of connective tissues or damaged muscles.

Swedish massage practitioners suggest that this approach can assist the body in delivering nutrients and removing waste products from various tissues. Therapy is said to transform nervous energy into a more steady state. Rhythm is regarded as important to establishing balance and the nervous system is thought to benefit from repetition and tempo. Rhythms are felt to have a meditative quality that is refreshing both to the therapist and client.

Environment is often regarded as being integral to massage therapy and often consists of a comfortable, warm, quiet location, although sports massage may be administered in a gym or locker room setting. Most approaches involve the client lying face down on a platform or table with a sheet covering the lower body. Depending on the technique, sessions may last from 15 to 90 minutes.

Training requirements for massage therapy in the United States varies. Many practitioners are not licensed, and national or international organizations have not reached consensus on standards. The International Therapy Examinations Council (ITEC) offers examinations testing the theoretical knowledge and practical ability (where applicable) of each and every candidate to ensure that their skills are of a sufficiently high standard to achieve an International Professional Qualification. It is recommended that patients seeking a massage therapist for medical reasons discuss the choice of massage practitioner with their primary healthcare professional. References and training history should be checked before starting a therapeutic program.

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

GRADE *

Various forms of massage are often used in patients with cancer with the aim to improve well-being and reduce anxiety. Additional scientific evidence is needed to draw a firm conclusion in this area.

B

Massage may help reduce aggressive behavior in adolescents, but there is currently not enough evidence on which to base a strong recommendation. More studies are needed to evaluate this use of massage.

C

Massage shows promise as an adjunct to traditional medical detoxification for alcohol. Further research is needed to confirm these results.

C

Several human trials have assessed the effects of massage in patients with anxiety, including those with cancer or chronic illnesses, hospitalized for psychiatric disorders, pre-operative anxiety- anxious about themselves or for their children having surgery, dementia, multiple sclerosis, before/during medical procedures, depressed adolescent mothers, women with premenstrual syndrome, patients with fibromyalgia, and in elderly institutionalized patients. Additional research is necessary in order to form a scientifically based recommendation.

Preliminary research suggests that aromatherapy used with massage may help to calm people with dementia who are agitated. However, it is not clear if this approach is any better than aromatherapy used alone.

C

Massage may benefit children with rheumatoid arthritis, but there is currently not enough scientific data on which to base a strong recommendation for this use of massage.

C

Promising initial evidence suggests that massage therapy may be beneficial to the lung function of children with asthma. Additional research is necessary before a firm conclusion can be drawn.

C

Massage administered by the parent may help children with atopic dermatitis. More studies are needed before recommendations for or against massage can be made in this condition.

C

Preliminary research suggests massage therapy may improve mood and behavior in children with ADHD. Additional evidence is needed before a recommendation can be made.

C

Massage may help improve sleep patterns, induce relaxation, and improve behavior patterns in autism. However, there is currently not enough data on which to base concrete recommendations in this condition.

C

Several human trials report temporary improvements in low back pain with various massage methods. A recent study showed slightly more efficacy for traditional therapy; however, the additional benefits of massage may add to its value for holistic nursing practice. Additional research is necessary in order to form a scientifically based recommendation.

There is some evidence from one small study suggesting massage may reduce stress in burn patients.

C

Early evidence suggests a possible benefit of calf massage for children with spastic diplegia, a form of cerebral palsy. However, more study is needed.

C

Massage has been used to treat nausea, anxiety, and depression in patients with breast cancer undergoing chemotherapy. Massage may help nausea, but effects on anxiety and depression in these patients is unclear.

C

Based on preliminary evidence, massage alone, or in combination with mindfulness-based stress reduction, may benefit patients with chronic pain. More research is needed to confirm these results.

C

A small number of human trials report that abdominal massage may be helpful in patients with constipation. Overall, these studies are not well designed or reported. Better quality research is necessary before a definitive conclusion can be reached.

C

Limited evidence suggests that simple massage techniques in the critical care unit may help reduce indices of stress and improve mood. More studies are needed.

C

Early evidence suggests that parent-administered massage may benefit mood and air flow in children with cystic fibrosis.

C

Massage with or without essential oils has been used in patients with dementia in chronic care facilities to assess effects on behavior. There is compelling early evidence that aromatherapy with essential oils may reduce agitation in patients with dementia, although the effects of massage itself are not clear.

C

There is insufficient evidence to determine if massage is beneficial in patients with major depressive disorder, situational mood disorders, critical illness, pregnancy, or postnatal depression (including infant massage).

C

There is early evidence suggesting that parental massage of children with diabetes may benefit blood sugar levels and symptom levels. There is also some evidence suggesting that self-massage of injection sites may increase insulin absorption.

C

Massage may play a role in enhancing the sensitivity and diagnostic ability of lymphatic mapping in breast cancer patients.

C

Sunflower therapy, which includes applied kinesiology, physical manipulation, massage, homeopathy, herbal remedies, and neuro-linguistic programming, has been studied for childhood dyslexia. Although initial research appears promising, additional studies are needed to make a firm recommendation.

C

Several studies of weak design have suggested that massage may benefit post-exercise muscle soreness. However, the data are insufficient to form definitive conclusions.

C

A small number of studies report that massage may improve pain, depression, and quality of life in fibromyalgia patients. Additional research is necessary in order to form a scientifically based recommendation.

C

There is insufficient evidence to determine if massage is beneficial in for improving hand grip strength. Early study results conflict.

C

Based on early study, massage may decrease blood pressure in hypertensive patients. More high-quality studies are needed.

C

Evidence is limited and mixed as to whether massage may be of benefit to immune functioning or health services utilization in people with HIV.

C

Limited study suggests a potential benefit for massage to help children recover from impairment of the central nervous system due to lack of oxygen. More study is needed.

C

There is insufficient evidence to determine if massage is beneficial in patients with iliotibial band friction syndrome.

C

Preliminary evidence suggests massage therapy may preserve immune function. Further research is needed before a firm conclusion can be made.

C

Massage has been used in pre-term infants by therapists or mothers with a goal to improve infant development and weight gain. It is not clear from existing studies if this is a beneficial therapy.

C

There is currently not enough scientific evidence available on whether massage is an effective therapy for migraine.

C

Initial research reports that massage may improve anxiety, depression, self-esteem, body image, and social functioning in patients with multiple sclerosis. Benefits on the disease process itself have not been well evaluated. Additional research is necessary before a firm conclusion can be drawn.

C

Preliminary research reports that massage may help relieve chronic pain. Soft tissue massage may also improve range of motion and function. Further well-designed study is needed to confirm these results.

C

Early evidence suggests that massage may reduce the number and intensity of painful trigger points. More studies are needed.

C

Massage limited to local areas of the body rather than full body massage may be beneficial in neck or shoulder pain. It remains unclear whether massage itself is effective, and if so, if it is more effective than acupuncture.

C

Early scientific evidence suggests that people with Parkinson's disease might have reduced symptoms after massage. More studies are needed.

C

Various massage approaches have been used after surgery with the aim to improve recovery and decrease pain. Further study is needed in this area before a recommendation can be made.

C

Various massage approaches have been used during pregnancy and labor and are more commonly used in Europe than in the United States. Reduction of pain or anxiety is a common goal. It is not clear how birth outcomes are affected or if this is a safe intervention. Women who are pregnant should consult with their obstetrician before beginning massage therapy.

C

Initial research of the effects of massage on mood in women with premenstrual dysphoric disorder (PMDD) is inconclusive. A recent study investigating abdominal meridian massage (Kyongrak) found positive effects for menstrual cramps and dysmenorrhea. Further study is needed before a recommendation can be made.

C

A small number of studies have attempted to evaluate the contribution of massage in preparation for invasive surgical procedures. However, results are mixed.

C

Hand massage did not appear to alter comfort levels or satisfaction with care in nursing home residents in one study. Larger, well-designed studies are needed before a recommendation can be made.

C

Early research suggests that massage as a means of general rehabilitation for the bedridden elderly or elderly living in long-term care facilities has not been demonstrated to have significant benefits. More studies are needed before a firm recommendation can be made.

C

Massage may be generally beneficial in rheumatic pain conditions. However, evidence is insufficient to make a strong recommendation.

C

It is unclear whether massage can reduce the severity of hypertrophic scarring in children. More studies are needed before this use of massage can be evaluated.

C

Early evidence suggests that massage may benefit patients with spinal cord injury. In these patients, abdominal massage may also have positive effects on bowel dysfunction. However, evidence is insufficient on which to base recommendations.

C

A 15-minute weekly massage has been studied for the reduction of physical and psychological stress in nurses. Massage was not beneficial for physical stress, but was found beneficial in reducing psychological stress levels. Further study is warranted.

C

* Key to grades

A: Strong scientific evidence for this useB: Good scientific evidence for this useC: Unclear scientific evidence for this useD: Fair scientific evidence for this use (it may not work)F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Safety
Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Few adverse effects of massage have been reported. Fractures, discomfort, bruising, swelling of massaged tissues, and a case of liver hematoma (internal bruising) have been reported. Vigorous massage should be avoided in patients with bleeding disorders, low platelet counts, or on blood-thinning medications (such as heparin or warfarin/Coumadin®). Based on preliminary study, blood pressure may increase in healthy patients following vigorous massage (e.g. trigger point therapy); however, in patients with hypertension, massage may actually lower blood pressure. Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Massage and other touch-based therapies should be used cautiously in patients with a history of physical abuse. Women who are pregnant should consult with their obstetrician before beginning massage therapy. Allergies or skin irritation can occur with some essential oils used in massage.

Massage has not been evaluated as a method to diagnose medical conditions. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.

Silva LM, Cignolini A, Warren R, et al. Improvement in sensory impairment and social interaction in young children with autism following treatment with an original Qigong massage methodology. Am J Chin Med 2007;35(3):393-406.

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.